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HomeMy WebLinkAbout0005 PHILLIPS ROAD 5 "Pf,� 11 i ps �cl, J -- — - - -- - �\� Town of Barnstable *Permit#(z Expires 6 r oQrissue date RMI1. Regulatory Services Fee 1639 a�� Thomas F.Geiler,Director -7 _1 p `1 1 209 Building Division I Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 TOWN OF BARNSTABLE www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMT APPLICATION - RESIDENTIAL ONLY Deb Not Valid without Red X-Press Imprint Map/parcel Number ,/ Property Address I*' IyA �li yS Ra4,9 s 11/'4 NNl J / MA 0 2 6 0/ [P'Residenfial Value of Work$ z �CI oll Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address/( 4 l/6 1'1 �l✓�V��S -, �������� �V��N� .3' Put1111 jj Kn g4A1,V1'S j Mg Contractor's Name G 9 y U V��A i</d!7 Telephone Number �d dG C,q l'22i' / /001C 2A f90tee M,6AA1 Zra t Home Improvement Contractor License#(if applicable) 40 7 f�d Email: �� /f'e d���2?i ��/!�P• eon Construction Supervisor's License#(if applicable) C 5 0 7 YU V4 ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ 1,am the Homeowner 034 have Worker's Compensation Insurance Insurance Company Name_ _ j �: �� '.RZ�� � % ��✓ �e Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to C,�NoFi/� ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side 3 [ Replacement Windows/doors/sliders.U-Value ®o (maximum.35)#of windows 40 hrq rc V EXi;rT� #of doors: /Av (M y ll� Co/ol✓ ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of he Home Improvement Contractors License&Construction Supervisors License is uire SIGNATURE: �, BN/10/1 C:\Users\decollik\Ap ata\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\8R76BDVA\EXPRESS.doc Revised 061313 CAPIHOM-01 CBENISCH CERTIFICATE OF LIABILITY INSURANCE DATD/YYYY) 6/121212/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer right's to`the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Chris Benisch Rogers&Gray Ins.-Dennis Branch PHONE FAX 434 Rte 134 a/c No E:t:(608)398-7980 A/c No):(877)816=2136 South Dennis,MA 02660 AIL ADDRess:cbenisch@rogemgray.com INSURERS)AFFORDING COVERAGE NAIC# INSURER A:Main Street America Assurance Co. INSURED INSURER B:Associated Employers Insurance Co. Capizzi Home Improvement,Inc. INSURER C Capizzi Enterprises,Inc. INSURER D 1645 Newtown Road Cotuit,MA 02635 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: } THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL S B POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICYNUMBER MM/DD MM/DD GENERAL LIABILITY EACH OCC 1,000,000 A X COMMERCIAL GENERAL LIABILITY MPB7075H 6/8/2013 6/8/2014 PREMISES URRENCE $ (Ea occurrence) $ 500,000 CLAIMS-MADE FXI OCCUR MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY JE Q LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ A ANY AUTO M1 M28044 6/8/2013 6/8/2014 BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED BODILY INJURY(Per accident) $ 500r 000 AUTOS AUTOS X HIREDALITOS X NON-OWNED PROPERTY DAMAGE $ AUTOS PER ACCIDE $ X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 5,000,000 A EXCESS LIAB HCLAIMS-MADE CUB1076H, 6/8/2013 6/8/2014 AGGREGATE $ DED I X I RETENTION$ 10,000 $ 5,000,000 WORKERS COMPENSATION WC TORYLIMITS X OETH R AND EMPLOYERS'LIABILITY B ANY PROPRIETOR/PARTNER/EXECUTIVE YIN WCCSO10647012012 12/25/2012 12/25/2013 E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N �N I A , (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ 1,000,000 ff yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Barnstable ACCORDANCE WITH THE POLICY PROVISIONS. 200 Main Street Hyannis,MA 02601-0000 AUTHORIZED REPRESENTATIVE @ 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Page 7 of.7 Capizzi Home Improvement Inc. Specifications and Estimates STATE OF MASSACHUSETTS :LETTER OF AUTHORIZATION TO APPLY FOR A BUILDING PERMIT Lrf o gjo(-��WN THE PROPERTY LOCATED AT S IN C Gl h (5 MASSACHUSETTS. I HAVE AUTHORIZED CAPIZZI HOME IMPROVEMENT TO ACT AS MY AGENT TO APPLY FOR A BUILDING PERMIT IN ACCORDANCE WITH 780 CMR, THE MASSACHUSETTS STATE BUILDING CODE. I GIVE MY PERMISSION TO - LESSEE TO APPLY FOR A BUILDING PERMIT IN ACCORDANCE WITH 780 CMR, THE MASSACHUSETTS STATE BUILDING CODE. SIGNATURE OF OWNER: f.. , �,(;� ,� 4, jVl$Vt � OWNER'S ADDRESS: OWNER'S TELEPHONE: - LESSEE'S SIGNATURE: - - LESSEE'S ADDRESS: LESSEE'S TELEPHONE APLLICANT'S SIGNATURE: APPLICANT'S ADDRESS: 1645 Newtown Rd., Cotuit, MA 02635 APPLICANT'S TELEPHONE: 508-428-9518 RESPONSIBLE OFFICER RESPONSIBLE OFFICER ADDRESS: RESPONSIBLE OFFICER TELEPHONE: Department o n ustrid ecidents Office of Investigations I Congress Street,Suite 100 -- Boston,MA 02114--2017 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information PIease Print Legibly Name(Business/Organization/Individual):Capizzi Home Improvement Address:1645 Newtown Road City/State/Zip:Cotuit, MA-02648 Phone #:508-428=9518 . Are you an employer?Check the appropriate box: 40+ Type of project(required): 11❑✓ I am a employer with 4• ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. E]Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity employees and have workers' No workers' comp.insurance . comp.insurance.$ 9• ❑Building addition required.] 5. ❑ We are a corporation and its IQ.El Electrical repairs or additions 3.[] I am,a homeowner doingall-Work officeis have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL _. 12.❑Roof repairs insurance required.]t c. 152, §1(4),_and'we have no employees.'[No workers' 13.[ Other 3 W .0 o y comp.insurance required.] *Any apr-cant that checks box#1 must also fill out the section below shov�"nng their workers'compensation oli` ' P P . Y inforn;�ation.�;•" f-Homeowners wf�p_ submit this affidavit indicating they are doing all work.-M then hire outside contractors must submit==new affidavit indicating such. #Contractors that check this box must attached an additional sheet showing�tbe name of the sub-contractors and state whether or not those entities have employie s. If the sub-eontractors have employees,they must provide their workers'comp..policy number I:ain an employer that is providing workers'compensation insurance for my employees Below is the policy and job site information. Insurance Company Name:Associated Employers Insurance Company Policy.#or Self-ins.Lic.#:WCC5010 547012011 12/25/201 D> /� Expiration.Date: Job Site Address: City/State/Zip: VA//1/®,1 44;VON Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure.to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for.insurance coverage verification. I do hereby certi nder the .ains and pen hies of erjury that the information provided above is true andcorrect ` Sianafore: Date: Phone#: 50 .28-951$ Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): Y:Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: Unrestricted-Buildings of any use group which contain less than 35,000 cubic feet(991M )of enclosed space. Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor Failure to possess a current edition of the Massachusetts License: CS-07-�.4640 State Building Code is cause for revocation of this license. GARY GUSTAFS9N For DPS Licensing information visit: www.Mass.Gov/DPS g SHORT WAY — SANDWICH MA%025 3 J,•�.-� � -ww Expiration Commissioner 77/29/2014 �1e Pamrnoozcaea�l/ o�, eaac�uaetta Office of Consumer Affairs&Business Regulation Peense or t e&WtiGn YaNd for IndWal un auly OME IMPROVEMENT CONTRACTOR before the eAp t>:an date. Iff€and tam Ia. icy ea of ChnsuiderAffairs Rud$ttSbW RepWou. uRegistration,'';-1,067 " Type 111,t1�,'�t•�CM -b`ake5170 - Expirafiqit_612,- 14 st4i1�R' 5 Supplement CAPIZZI HOME IP►30.VEM (?IT;INC. GARY GUSTAFSON '.r:<_::. _; :- 1645 Newton Rd. '•`. Cotuit,MA 02635 Undersecretary �P�#4titfgn8 ----- !1.11taattntttwa�sPa_ nt.+.i•aww+••••x ._@ fs..E.�_._C..r_.: Town of Barnstable *Permit#20 I mum = Regulatory Services Fee sa1g. ,+g Thomas F.Gellert Director Building Division Tom Perry, Building Commissioner �aS a� 200 Maier Street,-Hyannis,MA 02601 Vice: 508462-4038 Tp JU t 2 4 2006 T ,ax, 508 790-MO �//VVL 0P EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY'NS T.4 NotVatid without RedX-PresslmprW to /parcel Ntanber � tesidential Value of Work I Z j Minimum fee of$25.00 for work ender$60O0.00 ►er's Name&Address tractor_s_Naau . lea K ►r►^c r►%� p� - ►rt�y rnr�l� Telephone Number .5U�" Z��'3a?l it Improvement Contiactor License#(if applicable) l�S struction Stpervisor's License#(if applicable) Vorkman's Compensation Insurance Check one; Cl I am a sole proprietor ❑ I amihe Eomeowner a , have Worker's Compensation Insurance ranee Company Name L 1 6, �, lurtan's Cam.Policy#_ y of Itisuranee Compliance Certificate must be ou Ste. mt.Request(check box) Re-roof(stripping old shingles) All construction debris wtii be taken to_rT—):-:4-VI i f-I> t c, I�,n = n f ❑Re-roof(not stripping, Going over existing layers of roof) ❑ Re-side © Replacement Windows. U Value (maximum.44)- *Where ngeired: Issuance of ft petit does not exempt cornpTiance with athea town department regWatiaas,i.e.I- stone,Consavatiem,etc. ***Note. Property Owner mnst sign Property Owner Letter of Permission. Home Improvement Contractors License is required. - �ature MIS:expmtrg 463004 �aFti Town of Barnstable P Regulatory Services • sMR?WMLE, • y grass. $ Thomas F.Geiler,Director 2639. o°j°rFD na'�p10 Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I J egr-e Ry b.'n d , as Owner of the subject property hereby authorize � 14 c k e r so n H p rvI2 WN X DV1e me vy f to act on my behalf, in all matters relative to work authorized by this building permit application for: 5 P�qIt'Ps R� ; H VF KI"s vVLA-- (Address of Job) Signs e of er Date Print Name !1•F(1RARc.n�7UhiCDnt;or,rroornrT r �� LG!/Ki NiiG/ii V, l/iMii.7N NM Li{.{.NiG/Ii0 Office of Investigations 600 Washington Street Boston,MA 02111 . www.masSgov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plnmbers Aviahkant Information 1 Please Print Legibly Name(Business/Orgy nit ation/Individual)• l� C h f'o N ;v►nL '" v�"p ra y tv .�T Address: P.6 V 6)c City/State/Zip: :G r ,-eccn} i(/li{ ol(a-T 3 • Phone M SZk- LEI(- 3c, Are you an employer?Check the appropriate box: . Type of project(required): 4. ❑' l I am a genera contractor and I 1.�I am a employer with L 1 . .. b. El New construction . employees(full and/or part-time).* have hired me sub-cofactors . 7. ❑ Remodeling 2.❑ I an a sole proprietor or partner- listed on the attached sheet t ship and have no employees These sub-contractors have 8. 0 Demolition working for me in any capacity. worker's' comp.insurance. 9. ❑ Budding addition [No workers' comp.insurance 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions required.] officers have exercised their 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself[No workers' comp. c. 1.52,§1(4),and we have no 12.[aRoof repairs insurance required.]t employees. [No workers' 13.0 Other comp.insurance required.] 'Any applicant that checks box#1 must also fill oat the section below showing their workers'compensation policy information: t Homeowners who submit this affidavit indicating they we doing all work and then hire outside c ontmetors must submit anew affidavit indicating such tcontractm that check this box must attached an additional sheet showing the name of The sub-contractors and their workers'comp-policymformation. I am an employer that is providing workers'compensation insurance for any employe. Below is the popicy:and,job site reformation. 1 `,�{( q I Insurance Company Name: L (-A I},K 4 Policy#or Self-ins.Lia#: 0 3 , Expiration Date: City/Slate/Zip:/State/ �G A"Ii a MA c,Zt;c Job Site Address: S ���.�' ' �'c � � tY �� �- Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead in the imposition of criminal penalties of a fine up tp$1,500,00 and/or one-year imprisonment,as well as,civil penalties in the form of a STOP WORK ORDER.and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Sienature• Dater Phone# Official use only. Do not write in this area,to be completed by city.or town official City or Town: Permittl icense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#:. a, lntormation anu ximl U%;L1V"a ": W Massachusetts General Laws chapter 152 requires`all employers to provide workers' compensation for their employees. ' the service of another under any contract oflire; e person m defined as ...ev Pursuant to this statute, an employee�d every P express or implied,oral or written" An employer is defined as an individual,partnership,association,corporation or other legal entity,or any two or more : of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the arts , association or other legal entity,employing employees. However the receiver or trustee of an individual,P ershiP owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,const action or repair work,on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deem rbe PlOYer. MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold.the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence-of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance have been presented to the contracting authority." requirements of this chapter Applicants ,. Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s), address(es)and phone number(s)along with their certificate(s)of insurance Limited Liability Companies(I-LQ or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers'.compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit,should be returned to the city or town that`the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies-should enter their self-insurance license number on the appropriate line. City or Town Officials _ S Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications inany given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city'or gown)."A copy of the affidavit that has been of stamped or marked by the city or town may be provided to the applicant as proof fat,a valid affidavit is on file for future permits or licenses. Anew affidavit must be filled out each year.Where a home owner or citizen is obtaining a.license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit The Office of Investigations would bke to brink you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call.The Department's address,telephone and fax number: The Commonwealth of Massachusetts Depmlment of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 , Tel.#617-727-4900 ext 406 or 1-877 MASSAFE Fax#617-727-7749 li { �� ✓fie ��r�rea�aueallf o�✓T/lav;tac�ivae� Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR License or registration valid for individul use only before the expiration date. If found return to: Reglsfratlon: 133851 Board of Building Regulations and Standards Expiration: -8/17/2007 One Ashburton Place Rm 1301 Tyoe: Private Corporation Boston,Ma.02108, NICKERSON HOME IMPROVEMENT MARK NICKERSON 12 COMMERE DRIVE ORLEANS,MA 02653 `` °� Administrator Not valid without signature r e,ti i Liberty Mutual Group Liberty PO Box 7202 Mutual. Portsmouth,NH 03802-7202 Telephone(800)653-7893 Fax(603)431-5693 November 18, 2005 TOWN OF-BARNSTABLE ATTN: BLDG DEPT 200 MAIN ST HYANNIS.MA 02601- RE: Certificate of Workers Compensation Insurance Insured: NICKERSON HOME IMPROVEMENT INC PO BOX 2476 ORLEANS_MA 02653 Policy Number: WC.2-31S-31.81024035 Effective: 11/6/2005 Expiration.: 11/6/2006 Coverage afforded under Workers Compensation Law of the following state(s): MA Employers Liability: Bodily Injury By Accident: $ 1,000.000 Each Accident Bodily Injure by Disease: $ 1,000,000 Each Person Bodily Injury by Disease: $ 1,000,000 Policy Limits As of this date,the above-referenced policyholder is insured by Liberty Mutual Fire Insurance Co under the policy listed above. The insurance afforded by the listed policy is subject to all the terms, exclusions and conditions,and is not altered by any requirement,tern or condition of any or other documents with respect to which this certificate may be issued. This certificate is issued as a matter of infonnation only and confers no right upon you, the certificate holder. _ This certificate is not an insurance policy and does not amend, extend,or alter the coverage afforded by the policy listed above. If this policy is cancelled before the stated expiration date,Liberty Mutual will endeavor to notify you of such cancellation. l AUTHORIZED REPRESENTATIVE LIBERTY MUTUAL INSURANCE GROUP This Ceniticaae is executed by LIBERTY INRYMAL INSURANCE GROUP as respects such insurmce as is ad2btded by those companies. cc: insured: Producer of Record: NICKERSON HOME IMPROVEMENT INC PIKE INSURANCE AGENCY INC PO BOX 2476 P O BOX 1658 ORLEANS.MA 02653 ORLEANS.MA 02653 11l1 W2005 elf � a I Assessor's map and lot number ... /. .. ....................... F* FINE To /ewage Permit ..ember /'1.................................... ( SE /` SEPTIC SYSTEM MUST BE • //� !✓ e�_r INSTALLED IN COMPLIANCE t BAB101"IL LE, i House number ........................................................................ � MITI♦ TITLE '°o,, 039.a\�m� a MPY. TOWN OF BA/ - , AND f � 1 BUILDING 11SP,ECTOR C� t APPLICATION FOR PERMIT TO V..�:.l�i `,.:::............... ....................... M ,. ................................................... TYPEOF CONSTRUCTION ................................ '.a....................................................................... .............Two'C, ... ..19.k� TO THE INSPECTOR OF BUILDINGS: The undersigned hereby a �iets` for a permit according to the following information:inforrma�tion: Location . . ........�..� e 11_�� ,fX d. `':... ...i.e.��-o......`t � ................................................... ProposedUse ................ ... - \.1!Y� '....................................................................................................................... Zoning Distrj ...................z.... ........................................Fire District ........... C (`S'i!!. ................................ Name of Owner�� f` ......V4e......` ............Address ......:`:V..�. .....�e� z ....... 0 ' a Name of Builder .... .. - ...........Address Nameof Architect .................A................................................Address .........�......_..-._..1............................................................... Number of Rooms .......... .....1................................:...........Foundation ..... A.....0 .......... .!............. ...e�G 1............ Exterior ..... ... ...Roofing Floors ..... .......... ............... ...................Interior ........... .. .,. . ........................................... Heafiri .... .:°. ..........................................- . . g �.. ........:. .. .�.. . .............................Plumbing .............::.... ... ...'�:�:.. .__ _V. . . .. . Fireplace ............... ..................................................................Approximate Cost ......................� �:.�.lid.I�................................. Definitive Plan Approved by Planning Board --------------------------------19--------. Area ��..=�' J�. . .�....... Diagram of Lot and Building with Dimensions Fee Yl l' l�..... .... .................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH i I hereby agree to conform to all the Rules .and Regulations of the Town of Barnstable regarding the above construction. Name ..... F` ..... ..... I POND VIEW -REALTY TRUST ` —23633 iKo e Building ' ,1~� _o Permit for ` Dwelling .................... ..................................... Lot #15 5 Phillips, Rd. _ c le T - T Location ............................................ ................ 1 'Hyannis r ....................................... � Pond View Realty Trust- Owner .. .......................................................:.... - z Type of Construction• •,•••Frame ; . .... ... ... ........................................ ......... Plot ..... ........ .`. Lot ...:........................... _ `` f• - } . 14ovember 13, Permit Granted .........19 x Date of Inspection ............: ....19 Date Completed ....... ...�,�: .tP..`.. ,,, 19 �- j 1 ry ' trPERMIT REFUSED 4 � .. � 19 { ..... ... , .................. ....... ................... Y^.... .............- ........................................................... ............. .......................................... A .3 .... r Approved ..........:........... ... 19 15 ............................................................................... - ............. ........................................................ i rs71 t'J Tay51 ..� �' � � p -i �-. - t►t `�' � q . •� N s 1-10, LA p jj- 70 .. p i ft � t C a�IL `�i �,< M rl vi R qv , r r kA AD.t. F , _-- ..,_......... Tj , v 71 -P, •,, ( l a iN rD fit t " p -- x - TOWN OF BARNSTABLE Permit No. ___-2 3 6 3 8- Building Inspector .ra Cash ------------—g j__t-T - OCCUPANCY PERMIT Bond ________- __ __ Issued to Pond View Realty Trust Address Lot 15, . Phillips Road & Mi44--ohell a y7Ay, Hyannis f Wiring Inspector + Lam' Inspection date Plumbing Inspector. x Inspection date �",r� Gas Inspector �� x �t /' '• Inspection date Engineering Department Inspection date , Am r t Board of Health Inspection date THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR 'UPON SATISFACTORY .COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. r .. ... .....` 19. .._. ) BuildingInspector._.... ...._ .� . ...... �. x Assessor's map and lot nummber ......... ..... ...... THE I / � t, �OF Sewage Permit anwrmber r /� 1 J Z IIA"STADLE, i House number .....:........................ ........ NAM �0 r 9�0 3 9- . �0 'E0 YPy a TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ............... ,..................f "A. TYPE OF CONSTRUCTION � ............................... ............... .`.a fie` ...��'..19. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby a plies for a permit according to the following information: Location ...........................:.. .... � ...........�......................... :.. ILA Proposed Use .............. ` .. - l.� ................................................................ Zoning District ..........^...... ........................................Fire District ........... .................................. Name of Owne< '.. .... ............Address . .,..s ........ ! 4 Nameof Builder ....................................................................Address .................................................................................... Nameof Architect ..................................................................Address .................................................................................... Number of-Rooms ............... .................. ....................Foundation .......... Exlerior ............. ...`I1. ......................................Roofing ...........,-.'1 , d10 ................................................. Floors ........ - . .......................... ... ...................Interior ...........�1 y Her gting .... a.. ..... . ... ... ... . ............................Plumbing ................. ... . Fireplace ............... ....I..........................................................Approximate Cost ......................... t�................................ Definitive Plan Approved by Planning Board ________________________________19________. Area--w- ..r "�c�./... .:...... Diagram of Lot and Building with Dimensions Fee /' SUBJECT TO APPROVAL OF BOARD OF HEALTH 'j �s I hereby agree to conform to all thetlZules and Regulations of the Town of Barnstable regarding the above construction. ? . ;�,� Name ,�1C;!'~: .................. � ~ POND VIEW REALTY TRUST A=.291-6 . / y � � � 23638 Move ilcliog � No ................. Permit fo ................. Dwelling ---.----------------------.. , = . . � - I,(»t #15 5 Pbilli�a Rd 6 �ito��eIl �a� iocohon -------� . . ^ ' ---- --------.. . . ` ' � Hyannis --------------------------. ^ ' Pozld View Real ��znot ` ~_= -------------.=—'------ . . � ` Frame Type of Construction ...............................---.. . ............................................................ ------ ,p|ct ............................ Lot ` _' ---. ------. . � November 13, Ol ' ' ~ Permit Granted -------------.lV ` ' Date of Inspection ------------lP `^ Doo* Completed .......................................lg ' ' ' PERMIT REFUSED ................................................ 19 .......................................................... � -----' ' .............................. ................. , � ---------..�—� -----~----.' `~^ . � '� . � ^ ----^--'----^'^^^—~—~--^----^— . � Approved ................................................ lA ' � -------------.—.—.----.--.---. � --------------------~—^—'^^—